• Parveen Usman Aga Khan University
  • Habib Qaisar Aga Khan University
  • Anwar ul haque Liaquat National Hospital
  • Qalab Abbas Assistant Professor, PICU, AKUH, Karachi



Background: To compare the Paediatric RIFLE (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions of acute kidney injury (AKI) for frequency of (AKI) and in-hospital mortality in critically ill children. Methods: Retrospective review of medical records of all patients (aged 1 month – 16 years) admitted in Paediatric Intensive Care Unit from January 2015–December 2016, with length of stay >48 hours, was done. Patients with chronic kidney disease were excluded. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the p-RIFLE and KDIGO criteria to predict the AKI related mortality. Logistic regression analysis was done to determine the association of different variables with mortality in AKI patient based on p-RIFLE, KDIGO. A p-value of <0.05 was considered significant. Results: Out of total 823 patients admitted during the study period, 562 patients were included in the study. Median age was 2 years (Interquartile range 8 years). AKI frequency according to p-RIFLE and KDIGO were 391 (70%), and 372 (66%) respectively. Overall, 106/823 (12.8%) children died during study period, 78 (19.9%) in AKI by p-RIFLE and 76 (20.4%) in AKI by KDIGO died. The area-under- curve for in-hospital mortality for p-RIFLE and KDIGO criteria were 0.525 (p=0.427), and 0.534 (p=0.276), respectively. Conclusion: P-RIFLE is more sensitive compared to KDIGO in diagnosing AKI in critically ill children; identifying a greater number of moderate staged AKI cases. Greater AKI severity is associated with higher mortality in critically ill children.

Author Biographies

Parveen Usman, Aga Khan University

Senior Medical Offcier

Habib Qaisar, Aga Khan University

Senior Medical Officer

Anwar ul haque, Liaquat National Hospital



Bello-Reuss E, Reuss L. Homeostatic and Excretory Functions of the Kidney. In: Klahr S, editor. The Kidney and Body Fluids in Health and Disease. Boston, MA: Springer US, 1983; p.35–63.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8(4):R204–12.

Naik S, Sharma J, Yengkom R, Kalrao V, Mulay A. Acute kidney injury in critically ill children: Risk factors and outcomes. Indian J Crit Care Med 2014;18(3):129–33.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813–8.

Elapavaluru S, Kellum JA. Why do patients die of acute kidney injury? Acta Clin Belg 2007;62(Suppl 2):326–31.

Lex DJ, Toth R, Cserep Z, Alexander SI, Breuer T, Sapi E, et al. A comparison of the systems for the identification of postoperative acute kidney injury in Paediatric cardiac patients. Ann Thorac Surg 2014;97(1):202–10.

Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015;10(4):554–61.

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71(10):1028–35.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31.

Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, et al. Validation of the KDIGO acute kidney injury criteria in a Paediatric critical care population. Intensive Care Med 2014;40(10):1481–8.

Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for Paediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care 2011;15(3):R146.

Plötz FB, Bouma AB, van Wijk JA, Kneyber MC, Bökenkamp A. Paediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med 2008;34(9):1713–7.

Gao A, Cachat F, Faouzi M, Bardy D, Mosig D, Meyrat BJ, et al. Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. Kidney Int 2013;83(3):524–30.

Allen JC, Gardner DS, Skinner H, Harvey D, Sharman A, Devonald MAJ. Definition of hourly urine output influences reported incidence and staging of acute kidney injury. BMC Nephrol 2020;21(1):19.

Md Ralib A, Pickering JW, Shaw GM, Endre ZH. The urine output definition of acute kidney injury is too liberal. Crit Care 2013;17(3):R112.

Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory Paediatric septic shock. Paediatrics 1998;102(2):e19.

Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children. Clin J Am Soc Nephrol 2011;6(4):856–63.

Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, Investigators A. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017;376(1):11–20.

Alobaidi R, Morgan C, Goldstein SL, Bagshaw SM. Population-Based Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Children. Pediatr Crit Care Med 2020;21(1):82–91.

Gupta S, Sengar GS, Meti PK, Lahoti A, Beniwal M, Kumawat M. Acute kidney injury in Paediatric Intensive Care Unit: Incidence, risk factors, and outcome. Indian J Crit Care Med 2016;20(9):526–9.

Rodrigues FB, Bruetto RG, Torres US, Otaviano AP, Zanetta DM, Burdmann EA. Incidence and mortality of acute kidney injury after myocardial infarction: a comparison between KDIGO and RIFLE criteria. PLoS One 2013;8(7):e69998.

Hui WF, Chan WK, Miu TY. Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria. Hong Kong Med J 2013;19(1):13–9.

Gandhi J, Sangareddi S, Varadarajan P, Suresh S. Paediatric index of mortality 2 score as an outcome predictor in Paediatric Intensive Care Unit in India. Indian J Crit Care Med 2013;17(5):288–91.

Sethi SK, Raghunathan V, Shah S, Dhaliwal M, Jha P, Kumar M, et al. Fluid Overload and Renal Angina Index at Admission Are Associated With Worse Outcomes in Critically Ill Children. Front Pediatr 2018;6:118.

Basu RK, Kaddourah A, Goldstein SL, Investigators AS. Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study. Lancet Child Adolesc Health 2018;2(2):112–20.



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